ACC: Mood Boosters Bad for Arteries

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Explain that in this study of Vietnam veteran twins, those taking antidepressants had 5% more atherosclerosis of the carotid artery on ultrasound exam compared with those not taking any antidepressants.

Note that antidepressant use appeared to "age" carotid arteries by the equivalent of four years of atherosclerotic plaque accumulation compared with nonuse.

Point out that this was an observational study, could not determine causality, and the results may not generalize to women or other age groups with different renal clearance of medications.

NEW ORLEANS -- Antidepressants may boost mood at the expense of accelerated atherosclerosis for middle-age men, according to an observational study of more than 500 twins who had served in the Vietnam War.

The Vietnam vet twins taking antidepressants had roughly 5% more atherosclerosis in the inner lining of the carotid artery, with 37 μm greater intima-media thickness (IMT) compared with those not using any kind of antidepressant (P<0.05), Amit J. Shah, MD, of Emory University in Atlanta, and colleagues reported here at the American College of Cardiology meeting.

Antidepressant use appeared to "age" carotid arteries by the equivalent of four years of atherosclerotic plaque accumulation compared with nonuse, Shah said at a press conference where the study results were presented.

In the 59 pairs of veterans with only one twin on an antidepressant, the antidepressant user averaged 40 μm greater carotid IMT than his brother (P<0.01) after adjustment for depression, blood pressure, smoking, cholesterol, body mass index, and other potentially confounding factors.

"Each year that a person lives, naturally their carotid IMT increases by about 10 microns," Shah commented at the press conference.

This aging effect on blood vessels may be a factor to take into consideration in weighing the risks and benefits of antidepressant use in cases where patients aren't responding to the medication, Shah suggested.

Since carotid IMT predicts future stroke and heart attack risk, "we need more studies to verify findings such as these for this very important possible side effect," Shah told reporters.

Because it was an observational study, it could not determine causality, and the results may not generalize to women or other age groups with different renal clearance of medications, he cautioned.

"In terms of what to tell patients, it is definitely very case by case," he told MedPage Today. "Obviously antidepressants do provide a lot of benefit to people symptomatically. And since depression itself is a risk factor for future heart disease, it becomes a very thorny issue."

Many classes of antidepressants influence systemic levels of compounds like norepinephrine and dopamine that play a role in vasculature as well as mood, Shah explained. Serotonin, for example, resides primarily outside the brain where it impacts platelet aggregation and vascular tone, he pointed out.

Shah's group examined the association in 513 male twins (mean age 55, 95% Caucasian) in the Vietnam Era Twins Registry, which collected detailed medication histories and high resolution carotid ultrasound among measures for its primary aim of studying the impact of depression and post-traumatic stress syndrome on the cardiovascular system.

Twins take maternal and early environmental factors out of the equation -- as well as half or all of differences due to genetic factors, depending on whether twins are fraternal or identical.

In the cohort, 16% of the men were taking antidepressant medications.

The impact of antidepressant use on carotid IMT didn't appear to differ significantly by history of major depression (P=0.60 for interaction), which Shah pointed to as evidence supporting a potential role for antidepressants on carotid IMT thickening, rather than depression alone.

Deeper depression marked by higher depressive symptom scores did predict a greater effect of antidepressants on carotid IMT (P=0.049 for interaction), which Shah called effect modification "since, on average, depression does not associate with any change at all in carotid IMT."

Selective serotonin reuptake inhibitors didn't appear to differ from other antidepressants in their impact on atherosclerotic plaque accumulation as measured by carotid IMT.

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